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11
we are not patients. By making a premature assumption of the patient’s
cognitive competence, we deny the patient the opportunity to emotionally
process the shocking piece of news they have just received.
We would like to think that we offer a model of care that incorporates
good communication. Do we have the time to communicate appropriately?
What tools do we have to impart complex medical information to lay
people? Could our language alienate patients? In my work as a GP assessor
I frequently hear doctors use the work contraindications to patients. This
mostly falls on deaf ears.
"Check to see how your patient is feeling or what they are thinking
before giving a lot of information. A prognosis and treatment plan that
mitigates the impact on quality of life can bring hope, if delivered at
the right time. Ongoing communication would aid this. If your patient
is feeling overwhelmed, consider offering a follow-up appointment in
which to discuss implications, prognosis, treatment plans, and quality of
life issues."
Pressure of work may limit our ability to offer follow-up appointments.
Recent media coverage has highlighted the confict within ophthalmology
between the expectation of seeing new patients versus treatment plans
for existing patients. Is patient fow seen as a measurable commodity
for political purposes or is it a true measure of enhanced health care to
the community at large? In primary care, we are audited against many
outcomes. Can we be confdent that electronic records coding drug
misuse, for example, correlate with an encounter that actually confronts
the horrors in the patient’s life underlying the maladaptive behavior?
The former commodifes doctors as a data source, but the latter has the
potential to build trust and rapport with the patient.
We need to clarify whose needs we are actually meeting. Our primary
responsibility is to our patients. If this creates conficts with our funders
the profession needs to speak out.
"I had so many questions over the next few weeks and no way to
answer them. I tried calling my GP, but he was hesitant to comment.
The neurologist was diffcult to get hold of and hard to talk to over the
phone. Without knowing (or understanding) the correct language to
FEATURE